Leadership Skills

Slides by Colton Long, Ethan Krauspe, Alex Ryden, Brian Locke

Effective Leadership Skills

  1. Establish a clear leader
  2. Collaborate and share information

Scenario: RRT to RM S408.

Sign-out: 81M, SVT now stable.

Scenario: Situation

  • Suddenly, HR 160 and MAP drops 85 to 70

    What is this rhythm, and what would you do?

Scenario: Next Steps

What’s your schema for this situation?

What key data informs your treatment?

How do you convey your thinking to the room?

Scenario: Then…

You share your assessment and plan to administer IV metoprolol with the team, then…

  • 3 individuals (DOCTOR badges) you don’t know enter the room and don’t introduce themselves.

  • You discuss the situation with the family outside the room - many questions.

  • RN asks clarification: what metoprolol dose?

Scenario: New Rhythm

  • While with family, RN shouts “patient’s not responding”. New EKG:

    What is this rhythm, and what do you do?

Scenario (postscript)

  • DOCTORS are primary CV team, who are unaware it’s a rapid.

  • Primary team had also told the RN to give Metop, leading to multiple doses.

  • Patient required transcutaneous pacing - who decides?

What went wrong?

Establish a clear leader:

Are you running this RRT or not?

“I’m __, resident on the code team. Is anyone running this rapid?”

  • “Ok, I’m running this rapid”, or

  • “Can I take Over”, or

  • “OK, how can I help?”

Establish a clear leader:

Be the point person

Pit crew: everyone has a defined task and position

Do not move from your position. Don’t do it!

Collaborate and Share Information:

Invite suggestions with a constructive tone

Try:

  • Think out loud: “Wide QRS, but rhythm is irregular”

  • Summarize: “MAP is OK, I think this is AFib, so…”

  • Encourage: “Good thought, yes…”

Why?

  • Consider (actual) team dynamics: e.g. Resident-ICU RN, primary team

  • The team has a lot of context-specific experience

Scenario, Revisited

What would you do differently?

Scenario, Revisited

What would you do differently?

  • Primary team identified; confirmed they want you to run response

  • Standing at the head of the bed, delegating all other tasks.

  • You verbalize your rhythm interpretation schema.

  • Ideas from the entire team

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